Setting things “right”: right internal mammary artery on anomalous right coronary artery - a case report

Abstract

Anomalous aortic origin of a coronary artery (AAOCA) is a rare pathology that may cause episodic ischemia owing to possible vessel compression during systolic expansion of the aortic root. This anomaly can lead to myocardial infarction, malignant arrhythmias and sudden cardiac death (SCD). Several surgical techniques have been described; however, there are no defined guidelines regarding the treatment of AAOCA. We report the case of a 47-year-old woman with ectopic origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the proximal segment of the artery, running between the aorta and the pulmonary trunk. Revascularization was accomplished by harvesting the right internal mammary artery (RIMA) and anastomosing it to the anomalous RCA, given the small portion of the RCA following an intramural course and our familiarity with the procedure. The RCA was ligated proximal to the anastomosis to avoid the string sign phenomenon. This procedure is safe and fast and can be considered an alternative to coronary reconstruction.

Anomalous origin of the right coronary artery from the proximal segment of the left circumflex artery combined with acute myocardial infarction: a rare type L II-P single coronary artery

“…Although there are some case reports of the RCA having an abnormal origin ( 5 - 7 ), in most cases, the RCA originates from the distal LCx, while cases in which the RCA originates from the proximal end of the LCx are rare. A variety of methods can be used to determine the true anatomic distribution of abnormal coronary arteries as long as patient safety is not compromised ( 8 ).…”

“…Identifying anomalies is of paramount importance when intervention is necessary, including interventional or surgical therapy ( 7 , 24 ). The strategy for PCI should be carefully planned to avoid complications when there is an anatomical variation in the coronary artery.…”